1089 — Factors Influencing Receipt of Outpatient Rehabilitation Services among Veterans Following Lower Limb Amputation
Zhou J (Samuel S. Stratton VAMC), Bates BE
(Samuel S. Stratton VAMC), Kurichi JE
(University of Pennsylvania), Kwong PL
(University of Pennsylvania), Xie D
(University of Pennsylvania), Stineman MG
(University of Pennsylvania)
To determine patient-, treatment-, and facility-level characteristics associated with receiving outpatient rehabilitation services following lower extremity amputation within the Veterans Affairs (VA) healthcare system.
This observational study used data from 8 Veterans Health Administration (VHA) administrative databases and included 4,165 veterans who underwent lower limb amputations in VA facilities. Data included information up to the one year post surgical date. A Cox regression model was used to determine the hazard ratio (HR) and 95% confidence interval (CI) of veterans receiving outpatient rehabilitation services.
Sixty-four percent of veterans with lower extremity amputation received outpatient rehabilitation services. Factors associated with the receipt of outpatient rehabilitation services include: amputation etiology of device infection (HR = 1.17, 95% CI, 1.04-1.32); comorbidities of drug abuse (HR = 1.34, 95% CI, 1.07-1.68) and hypertension (HR = 1.10, 95% CI, 1.02-1.19); or treatment in the Midwest region compared to the Southeast (HR = 1.17, 95% CI, 1.05-1.31). Marriage was associated with increased likelihood of receiving outpatient rehabilitation services over time. Factors negatively associated with receiving outpatient rehabilitation services include: admission for the surgical amputation from extended care compared to a transfer from another hospital (HR = 0.37, 95% CI, 0.27-0.50); comorbidities of deficiency anemias (HR = 0.91, 95% CI, 0.82-0.99) and neurological disorders (HR = 0.69, 95% CI, 0.52-0.92); procedures for severe renal disease during the surgical hospitalization (HR = 0.76, 95% CI, 0.65-0.88); receiving inpatient consultative rehabilitation compared to inpatient specialized rehabilitation services (HR = 0.82, 95% CI, 0.74-0.91); and treatment in the Northeast region compared to the Southeast (HR = 0.76, 95% CI, 0.66-0.86). Age, types of amputation other than unilateral trans-tibial, and comorbidities including congestive heart failure and psychoses, or procedures for serious nutritional compromise were associated with decreased likelihood over time.
Both clinical characteristics and the types of rehabilitation services received appear to influence receipt of outpatient rehabilitation services following lower extremity amputation in the Veteran population. Geographic location also impacted receipt of outpatient rehabilitation, suggesting that care patterns are not standardized across the nation.
As VA strives to provide high quality, equitable services, an understanding of real world factors that result in variations can lead to overall improvements in the health care system.